PB2341: EARLY MORTALITY VARIABLES IN PATIENTS OLDER THAN 75 YEARS WITH DIFFUSE LARGE B-CELL LYMPHOMA
Authors: Mónica Fernández Pérez, Laida Cuevas Palomares, Ernesto Pérez Persona, Xabier Gutierrez Lopez De Ocariz
Journal: HemaSphere (2023)

Topic: 19. Aggressive Non-Hodgkin lymphoma - Clinical Background: Diffuse large B-cell lymphoma (DLBCL) is the most common form of adult non-Hodgkin lymphoma (NHL). Numerous factors have been related to the prognosis of DLBCL, but none of them have sufficient individual prognostic effect to condition clinical decisions. The patients with DLBCL suppose a therapeutic challenge due to comorbidities, presenting an increased risk of early death. Aims: The main objective is to identify the variables that predict the risk of early death or complications in patients with DLBCL. Methods: This is a retrospective, unicentric study of the University Hospital of Araba (HUA). Patients diagnosed with DLBCL between 1/01/2014-31/12/2021 and who died at the time of the study were selected. The variables that were collected, through the retrospective review of the clinical history, in a data collection notebook (CRD) were: age, gender, histological type and comorbidities. As well as the scales of fragility and comorbidity: International Prognostic Index (IPI), Charlson, Cumulative Illness Rating Scale (CIRS), Barthel and body mass index (BMI), analytical parameters such as fibrinogen, albumin and lymphocytes and the treatment received. Results: We included 78 patients who met the selection criteria. The median age of the included patients was 82 years. Of these, 43.58% died in the first year after diagnosis. The histological type of deceased patients was 53% for non-classificable patients, 20.6% germinal center B-cell-like and 26.4% for non-germinal center B-cell-like. Assessing the multipathology of the patients who died one year after diagnosis, it was observed that they presented in a higher percentage vascular disease (p<0.001), diabetes mellitus (p 0.631), chronic obstructive pulmonary disease (COPD) (p<0.024), heart failure (p 0.000), dementia (p 0.000), arterial disease (p 0.083), chronic kidney disease (p 0.036) and high BMI (25-35 vs 16-24) (p 0.040). Taking into account fragility parameters, an increased risk of death was observed in patients with elevated IPI (IPI: 4-5 vs 1-3) (p 0.003) and with elevated Charlson (5-8 vs 1-4) (p 0.000). As well as in patients with high CIRS (15-30 vs 0-15) (p = 0.000) and with a lower Barthel (<60 vs 60-100) (p = 0.000). Reviewing the analytical values of the patients, it was observed how patients with hyperfibrinogenemia (>500) had a worse prognosis (p 0.000), as well as those with hypoalbuminemia (2-3.5 vs 3.6-4.5) (p <0.001) and lymphopenia (0-1000 vs 1100-5000) (p 0.253). In 1st line, the treatment with the best response in less fragile patients was R-COP, followed by R-mini-CHOP. Of the total number of patients with non-hematological events, 77.5% died one year after diagnosis. Summary/Conclusion: The population over 75 years of age with DLBCL is very heterogeneous. In our study we found that the fragility of patients has an impact on the therapeutic decision and on the risk of death one year after diagnosis, so it is necessary to carry out an adequate geriatric assessment to adapt the treatment to the clinical situation of the patients.Keywords: Diffuse large B cell lymphoma